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Observational Study
. 2022 Feb;37(2):433-441.
doi: 10.1007/s00467-021-05162-0. Epub 2021 Aug 12.

The effect of continuous venovenous hemodiafiltration on amino acid delivery, clearance, and removal in children

Richard P Lion  1 , Molly R Vega  2 , E O'Brien Smith  3 , Sridevi Devaraj  4 , Michael C Braun  2 , Nathan S Bryan  3 , Moreshwar S Desai  1 , Jorge A Coss-Bu  1 , Talat Alp Ikizler  5 , Ayse Akcan Arikan  6   7   8
Affiliations
Observational Study

The effect of continuous venovenous hemodiafiltration on amino acid delivery, clearance, and removal in children

Richard P Lion et al. Pediatr Nephrol. 2022 Feb.

Abstract

Background: In critically ill children with acute kidney injury (AKI), continuous kidney replacement therapy (CKRT) enables nutrition provision. The magnitude of amino acid loss during continuous venovenous hemodiafiltration (CVVHDF) is unknown and needs accurate quantification. We investigated the mass removal and clearance of amino acids in pediatric CVVHDF.

Methods: This is a prospective observational cohort study of patients receiving CVVHDF from August 2014 to January 2016 in the pediatric intensive care unit (PICU) of a tertiary children's hospital.

Results: Fifteen patients (40% male, median age 2.0 (IQR 0.7, 8.0) years) were enrolled. Median PICU and hospital lengths of stay were 20 (9, 59) and 36 (22, 132) days, respectively. Overall survival to discharge was 66.7%. Median daily protein prescription was 2.00 (1.25, 2.80) g/kg/day. Median daily amino acid mass removal was 299.0 (174.9, 452.0) mg/kg body weight, and median daily amino acid mass clearance was 18.2 (13.5, 27.9) ml/min/m2, resulting in a median 14.6 (8.3, 26.7) % protein loss. The rate of amino acid loss increased with increasing dialysis dose and blood flow rate.

Conclusion: CVVHDF prescription and related amino acid loss impact nutrition provision, with 14.6% of the prescribed protein removed. Current recommendations for protein provision for children requiring CVVHDF should be adjusted to compensate for circuit-related loss. A higher resolution version of the Graphical abstract is available as Supplementary information.

Keywords: CKRT; Critical care nephrology; Dialysis; Nutrition; Pediatric nephrology.

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References

    1. Kaddourah A, Basu RK, Bagshaw SM, Goldstein SL, AWARE Investigators (2017) Epidemiology of acute kidney injury in critically ill children and young adults. N Engl J Med 376:11–20. https://doi.org/10.1056/NEJMoa1611391
    1. Gupta S, Sengar GS, Meti PK, Lahoti A, Beniwal M, Kumawat M (2016) Acute kidney injury in pediatric intensive care unit: incidence, risk factors, and outcome. Indian J Crit Care Med 20:526–529. https://doi.org/10.4103/0972-5229.190368 - DOI - PubMed - PMC
    1. Hui WF, Chan WK, Miu TY (2013) Acute kidney injury in the paediatric intensive care unit: identification by modified RIFLE criteria. Hong Kong Med J 19:13–19 - PubMed
    1. Basu RK, Wheeler DS, Goldstein S, Doughty L (2011) Acute renal replacement therapy in pediatrics. Int J Nephrol 2011:785392. https://doi.org/10.4061/2011/785392 - DOI - PubMed - PMC
    1. Boschee ED, Cave DA, Garros D, Lequier L, Granoski DA, Guerra GG, Ryerson LM (2014) Indications and outcomes in children receiving renal replacement therapy in pediatric intensive care. J Crit Care 29:37–42. https://doi.org/10.1016/j.jcrc.2013.09.008 - DOI - PubMed

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